Forms and Publications
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For Active Members
Beneficiary Nomination (R0315C)
This form designates a beneficiary for a
monthly pension in the event of the death of an active public school
employee.
Name and Address Change (R0357X)
Use this
form to change your name and address with ORS.
Eligible Domestic Relations Order (EDRO)
(R0259C)
An EDRO is a specific type of court order that
provides instructions for dividing a public pension as part of a divorce.
It applies only to active and deferred members of a pension system. ORS
developed this online fillable form to allow members of the Michigan Public
School Employees' Retirement System to created accurate and complete EDROs
that can be administered under the retirement statutes. It is the preferred
document to file with ORS. Background information and instructions are
provided separately in Eligible Domestic Relations Orders: Background and Instructions
(R0911X).
Eligible Domestic Relations Order: Background and
Instructions (R0911X)
Important instructions and background
information, and examples for completing an Eligible Domestic Relations
Order that complies with retirement statutes. This information will help
you understand how an EDRO will affect your pension.
Publication: Your Retirement Plan: A Member Handbook for Michigan's Public
School Employees
This plan overview is a useful reference at any stage in your career. It
provides general information about your retirement plan, as well as
suggestions for long-term retirement planning.
Back to top.
Service Credit Applications
Universal Buy-In - Contact ORS and
request a Member Billing
Statement.
Parental Leave (R0008C)
If you reduced
your hours or left public school employment for parental leave you may be
eligible to buy up to five years of retirement credit for those time
periods.
Out-of-System or Nonpublic Educational Credit
(R0149C)
As an active member of the Michigan Public
School Employees Retirement System, you may purchase out-of-system and
nonpublic educational service at any time.
Military Service Credit (R0081C)
Use this form to
apply for service credit for time you spent in active duty military
service.
Sabbatical Leave Credit (R0148C)
As an
active member of the Michigan Public School Employees Retirement System,
you may receive credit for an authorized sabbatical leave of absence.
State of Michigan Credit (R0317C)
Use
this form to receive retirement credit for the years you worked for the
state of Michigan and were a member of the State Employees' Retirement
System.
Weekly Workers Compensation Credit (R0285C)
Use this form to request service credit for weekly
workers' compensation (WWC) paid to you before July 1, 1992 only.
Comprehensive Employment and Training Act (CETA) - Contact ORS to
request.
If you are interested in increasing your pension amount, or
qualifying earlier, by adding to your service credit, please visit
the Service
Credit - Earning & Purchasing section on our website where you
can find up-to-date information that details the types of service credit
available, how to apply, and different ways to pay.
Back to top.
Tax-Deferred Payment and Rollover Forms
Service Credit Payment Options
(R0648C)
Summarizes the ways you can pay for your
service credit purchase.
TDP Agreement (R0392C) - Contact ORS to
request.
Qualified Plan-to-Plan Transfer Certification
(R0158X)
This form is used if you wish to transfer funds
from a qualified retirement plan (401(a), 401(k), 403(b), or 457) to
purchase service credit.
Supplemental TDP Agreement (R0654C)
Use this
form only if you have a current Tax-Deferred Payment (TDP) agreement
and wish to increase a tax-deferred payroll deduction.
Payoff Payment Options for a TDP Agreement (R0518C)
You can use this form only if you are retiring or terminating employment
and need to pay off a current Tax-Deferred Payment (TDP)
agreement.
TDP Agreement Addendum (R0625C)
Use this
form to transfer a TDP agreement to a new Michigan public school
employer.
Back to
top.
For Terminating or Deferred Members
Beneficiary Nomination Form (R0315C)
This form designates a beneficiary for a monthly pension in the event
of the death of an active public school employee.
Refund Application (R0311C)
Use this form if
you have terminated employment and would like to withdraw your
contributions on account with the Public School Employees Retirement
System.
Name and Address Change (R0357X)
Use
this form to change your name and address with ORS.
Payoff Payment Options for a TDP Agreement
(R0518C)
You can use this form only if you are
retiring or terminating employment and need to pay off a current
Tax-Deferred Payment (TDP) agreement.
Publication: Leaving Public School Employment?
If you're not yet eligible to retire, either because you don't have enough
service credit ot you're too young to qualify for a monthly pension, this
publication will help you understand how your retirement plan will be
affected.
Back to
top.
Apply for Retirement
Application for Retirement - miAccount
miAccount is the fastest and easiest way to apply for retirement - 5 simple
steps and you're done!
Applying for Retirement: What You'll Need
(R0870C)
Print this worksheet to use as a reference when you
apply online. This will help you gather the information you'll need to
complete your application. You can also take notes that will be helpful as
you apply, especially if you're not using your own computer.
Insurance Information (R0058C)
This document
provides you with basic information about the health, dental, and vision
insurance coverage available to retirees.
Insurance
Options Summary (R0379C)
Federal Income Tax Withholding Authorization Worksheets
(R0727X)
Use this form to determine how many allowances to
claim or if you should request additional money to be withheld on your
Federal Income Tax Withholding Authorization in your retirement
application.
Publication: Retirement Readiness: A Two-Year Countdown
For members who are within a few years of retiring. This book contains
specifics on how pensions are calculated, the various payment options, how
to prepare for retirement, and the application process.
Back to top.
For Disability Applicants
Publication: If You Become Disabled: Your Disability Protection
For members who are facing an illness or injury that prevents them from
working. This brochure defines the criteria to receive a
disability benefit and gives an overview of the application
process.
Back to
top.
For Retirees
3rd Party/Independent Contractor Retiree Rehire/Termination
Certification (R0851C)
If you retired on or after
July 1, 2010, and you will be returning to work, either directly or
indirectly, in a Michigan public school or any charter school in Michigan,
you and your employer will both need to complete this form. Your employer
is responsible for returning the form to ORS.
Insurance Enrollment/Change Request (R0452C)
Use this form to enroll in one or more of the retirement system insurance
plans, change from one health plan to another, or add, delete, or change a
name for anyone on your existing insurance coverage. Also use this form to
notify the Office of Retirement Services (ORS) if you or any of your
covered dependents become eligible for Medicare or other health, dental,
vision or prescription group insurance coverage.
Direct Deposit Application (R0277X)
Use this application to have your monthly pension automatically deposited
into your checking account or savings account.
Name and Address Change (R0357X)
Use
this form to change your name and address with ORS.
Insurance Information (R0058C)
This document provides you with basic information about the health, dental,
and vision insurance coverage available to retirees.
Insurance Options Summary (R0379C)
Insurance Rates (R0072C)
Income Tax Withholding Authorization (R0012X)
Use
this to change the federal and Michigan income tax withholding on your
retirement pension.
Domestic Relations Order (DRO) (R0323X)
A Domestic Relations Order (DRO) is a specific type
of court order that provides instructions for dividing a public pension as
part of a divorce. It applies only to retired members of a pension system.
ORS has developed a downloadable, fillable form to allow you to create
accurate and complete DROs that can be administered under the retirement
statutes. This interactive PDF prevents errors by not allowing
contradicting selections, by prefilling information, preventing
typographical errors, and by offering pop-up help screens. It is
the preferred document to file with the Office of Retirement
Services. This is the fastest, most efficient way to complete your
filing. Complete it online, save it, print it, then take the printed copy
to the court for the judge's signature. Background information,
instructions, and examples are provided separately in Domestic Relations Orders: Background and Instructions
(R0912X).
Domestic Relations Order to Void the Survivor Option Only
(R0914CGB)
This downloadable, fillable form
simplifies the voiding of a survivor option of a Domestic Relations Order
(DRO) in circumstances when the void language is not included in the
judgment of divorce. This interactive PDF prevents errors by prefilling
information, preventing typographical errors, and by offering pop-up help
screens. It is the preferred document to file with the Office of
Retirement Services. This is the fastest, most efficient way to
complete your filing. Complete it online, save it, print it, then take the
printed copy to the court for the judge's signature. Background
information, instructions, and examples are provided separately in
Domestic Relations Orders: Background and Instructions
(R0912X).
Domestic Relations Orders: Background and Instructions
(R0912X) Important instructions, background information, and
examples for completing a Domestic Relations Order that complies with
retirement statutes. This information will help you understand how a DRO
affects your pension.
Refund
Beneficiary Designation for Retirees (R0748X)
Use this form
to change your retirement refund beneficiary.
Publication: After You Retire: What Every Pension Recipient Should Know
booklet
You will receive this booklet when you apply for your pension. It tells you
what to expect, and how and when you should contact ORS after your
retirement benefits begin.
Back to top.
Publications
Your Retirement Plan: A Member Handbook for Michigan's
Public School Employees
This plan overview is a useful
reference at any stage in your career. It provides general information
about your retirement plan, as well as suggestions for long-term retirement
planning.
Retirement Readiness: A Two-Year
Countdown
For members who are within a few years of
retiring. This book contains specifics on how pensions are calculated, the
various payment options, how to prepare for retirement, and the application
process.
After You Retire: What Every Pension Recipient Should
Know
You will receive this booklet when you apply for
your pension. It tells you what to expect, and how and when you should
contact ORS after your retirement benefits begin.
Leaving Public School Employment?
If you're
not yet eligible to retire, either because you don't have enough service
credit or you're too young to qualify for a monthly pension, this
publication will help you understand how your retirement plan will be
affected.
If You Become Disabled: Your Disability
Protection
For members who are facing an illness or
injury that prevents them from working. This brochure defines the criteria
to receive a disability benefit and gives an overview of the
application process.
Comprehensive Annual
Financial Report (CAFR)
Back to top.
